Post by Diane on Jan 15, 2005 11:12:05 GMT -5
www.pendulum.org/related/related_add_barkley.html
Dr. Barkley's ADHD Seminar Notes
Dr. Russell Barkley, widely considered to be the leading research psychologist working on ADHD, is Director of Psychology and Professor of Psychiatry and Neurology at the University of Massachusetts Medical Center. He has authored several books on attention deficit disorder, including the classic 'Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment.' The following notes are from a seminar Barkley presented in Cleveland on 29 April 1994. The seminar was sponsored by the Institute for Adult Development and the Institute for Child & Adolescent Wellness in Beachwood, Ohio.
While compiling these notes, the liberty was taken of replacing such terms as 'normal' with 'average'. For while ADD certainly impairs the ability of people to function with expected efficiency at certain tasks in industrialized societies, it is not to be seen merely as a disorder. Lets not minimize ADD, but lets not pathologize it either. Indeed, many psychologists now speak of ADD as an outlier in the spectrum of human neurological variation, and therefore little different from other genetically-determined human traits like hair or eye color, height, intelligence, etc. As Thom Hartmann and Ned Hallowell have advocated, ADD should be seen as much as a gift, and indeed many people with ADD have high intelligence, whether inborn or acquired as a compensating response necessary to function in a complex society. While much of Barkley's presentation was oriented toward ADD children, the extensions to adult ADD are in most cases straightforward. Note that one does not necessarily have to agree with all of Barkley's views, (especially with regard to a single cause underlying all ADHD) in order to gain useful information from this essay.
The notes below, were not taken from any recording. Notes may be redistributed only if the above commentary is included.
--------------------------------------------------------------------------------
Russell Barkley seminar on ADHD
Calling ADHD an attention disorder trivializes it; it is not an attention deficit. Barkley is working on a new theory to explain the psychobiology beneath the spectrum of symptoms usually considered to be part of the ADD syndrome. All of these symptoms are observed in 'normal' people at one time or another - they differ in people with ADHD by reason of their presence since childhood, their persistence beyond childhood, and their severity.
ADD has in the past been termed post-encephalitic behavioral disorder, brain-injured child disorder, and minimal brain disorder. The hallmark triad of symptoms are:
inattention or inconsistent attention,
hyperactivity
impulsiveness.
Barkley says that ADD has more to do with lost interest than with an inability to concentrate. He estimates that ADD affects 2 million children in the USA, with the condition persisting into adulthood in chronic form in over 50% of these. Boys are affected at three times the rate. ADD crosses all social barriers, and is present is all ethnic groups and social classes.
Barkley says that it is misleading to speak of three primary characteristics of ADD. Might a single underlying cause account for the wide range of characteristic behaviors? He believes so, and points to persistence of effort as the cornerstone of ADD. Some think ADD arises from a faulty 'filtering' mechanism, but this is not the case - it has to do with motivation. As a result, telling children or adults to try harder is futile and should be stopped - rather, the interest of the curriculum (or job, etc.) should be increased to keep ADD children interested and motivated.
ADD is not an attention disorder, but a disorder of impulse control. ADD children do things other kids think of, but don't actually do. The urge to act is not being inhibited. The first response is the immediate response. People with ADD have trouble resisting the attractiveness of things other than that immediately before them. The observed hyperactivity is not independent from, but born of, the impulse control problem. To be ADD is to be hyper-responsive, not hyperactive. Failure to inhibit is at the core of the problem.
ADD has an early onset. 95% are identified by age 7; the mean is age 4. By this time, 'normal' children are learning self-control. All young children are impulsive, but they eventually learn control. 20-30% outgrow the condition. >60% (Barkley thinks it to be 75%) carry the condition in some form into adulthood.
ADD children act better in a one to one setting than in groups. They behave better in the presence of fathers than mothers. This is also observed in other children. Barkley thinks that in the mind of the child, the person (parent) who talks loses, the one who acts wins. Mothers tend to talk; fathers tend to act. He suggests that you not try to reason with your children in every situation - ADD is not a failure of reason, neither is it a failure of knowledge.
For the person with ADD, novelty is a reward. They do well with a rich schedule of feedback. Barkley calls them 'little Ed Kochs', for the New York City mayor known for asking 'How'm I doing?'. Tell them how they are doing - they want immediate feedback, for they operate on the level of immediate vs. delayed consequences/rewards. Education is delayed gratification; they want what feels good now. Those with ADD generally do better in the morning (even those who are not 'morning people' find it easier to function more close to normal in the morning). Therefore, give them the hard work in the morning, and give them something fun to do later. Its important to realize that symptoms are dependent on the environment; one is not going to see all the problems under all circumstances.
The scientist/philosopher Jacob Bronowski wrote in 'The Ascent of Man' that the most crucial event in the evolution of the human species was the appearance of the ability to wait - a trait crucial for human function. Barkley sees four aspects to this ability to wait.
1. A sense of time
The human mind can keep an event in short-term memory. The mind can freeze time by holding on to an event which has passed. Barkley's theory of the neuropsychology of ADD predicts that people with ADD will have poorer short-term memory than average individuals. If you can hold something in short-term memory you can analyze it. This ability is crucial for mental calculations, analysis, reflection. Humans can use their minds as time machines, as vehicles in which to travel between the present, past and future. Other animals cannot sustain an image in their minds. We call the ability to refer back and forth between past and present hindsight. If however, you don't wait, you don't reflect, and therefore cannot benefit as well from the wisdom of hindsight.
We are the only species in the fourth dimension: time. This sense develops between 7 and 8 years of age. Conversation at this age begins to deal with anticipation, forethought, planning. Other kinds learn to ignore stimuli which may distract from the task at hand. In contrast, the ADD child doesn't respond until the event crosses their window. They don't respond until hit by the train of time. They don't deal with things until necessary.
2. Objectivity
Once you learn to wait, you can stop an emotional response while you examine it. This is emotion vs. objectivity. I you don't wait, you will continue to be emotional, and will have difficulty separating emotion from objectivity. It's facts vs. feelings. Those with ADD are more emotional over the entire spectrum, from happy to sad; they feel their emotions more intensely than average people.
Objectivity is required to serve goal-directed behavior. Perspicacity is the kindling of motivation. Motivation is an emotion. The normal attitude with an unpleasant task is that you 'stick with it', as there is a reward at the end. In ADD, the reward must be in the task itself, not after it. Most children can kindle motivation, the ADD child has to find it in what he is doing at the time - he has trouble kindling motivation to do an unpleasant task.
3. Reflection
Humans can turn language on themselves. We call it reflection, and its the bedrock of self-control. Internalized language develops at 3-4 years of age; it is therefore no surprise that ADD is typically first noticed at this age. Speech becomes a means for self-control. You can talk to yourself in order to control yourself. This predicts disorganized internal speech in those with ADD. This was actually seen in research done 10 years ago, but it was ignored because it didn't fit into the prevailing paradigm.
The prediction is that those with ADD will seem younger than their chronological age; they will seem more child-like than their non-ADD peers. That is why ADD children are so 'chatty' and why much of their conversation deals with the present, and not the future.
Dr. Barkley's ADHD Seminar Notes
Dr. Russell Barkley, widely considered to be the leading research psychologist working on ADHD, is Director of Psychology and Professor of Psychiatry and Neurology at the University of Massachusetts Medical Center. He has authored several books on attention deficit disorder, including the classic 'Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment.' The following notes are from a seminar Barkley presented in Cleveland on 29 April 1994. The seminar was sponsored by the Institute for Adult Development and the Institute for Child & Adolescent Wellness in Beachwood, Ohio.
While compiling these notes, the liberty was taken of replacing such terms as 'normal' with 'average'. For while ADD certainly impairs the ability of people to function with expected efficiency at certain tasks in industrialized societies, it is not to be seen merely as a disorder. Lets not minimize ADD, but lets not pathologize it either. Indeed, many psychologists now speak of ADD as an outlier in the spectrum of human neurological variation, and therefore little different from other genetically-determined human traits like hair or eye color, height, intelligence, etc. As Thom Hartmann and Ned Hallowell have advocated, ADD should be seen as much as a gift, and indeed many people with ADD have high intelligence, whether inborn or acquired as a compensating response necessary to function in a complex society. While much of Barkley's presentation was oriented toward ADD children, the extensions to adult ADD are in most cases straightforward. Note that one does not necessarily have to agree with all of Barkley's views, (especially with regard to a single cause underlying all ADHD) in order to gain useful information from this essay.
The notes below, were not taken from any recording. Notes may be redistributed only if the above commentary is included.
--------------------------------------------------------------------------------
Russell Barkley seminar on ADHD
Calling ADHD an attention disorder trivializes it; it is not an attention deficit. Barkley is working on a new theory to explain the psychobiology beneath the spectrum of symptoms usually considered to be part of the ADD syndrome. All of these symptoms are observed in 'normal' people at one time or another - they differ in people with ADHD by reason of their presence since childhood, their persistence beyond childhood, and their severity.
ADD has in the past been termed post-encephalitic behavioral disorder, brain-injured child disorder, and minimal brain disorder. The hallmark triad of symptoms are:
inattention or inconsistent attention,
hyperactivity
impulsiveness.
Barkley says that ADD has more to do with lost interest than with an inability to concentrate. He estimates that ADD affects 2 million children in the USA, with the condition persisting into adulthood in chronic form in over 50% of these. Boys are affected at three times the rate. ADD crosses all social barriers, and is present is all ethnic groups and social classes.
Barkley says that it is misleading to speak of three primary characteristics of ADD. Might a single underlying cause account for the wide range of characteristic behaviors? He believes so, and points to persistence of effort as the cornerstone of ADD. Some think ADD arises from a faulty 'filtering' mechanism, but this is not the case - it has to do with motivation. As a result, telling children or adults to try harder is futile and should be stopped - rather, the interest of the curriculum (or job, etc.) should be increased to keep ADD children interested and motivated.
ADD is not an attention disorder, but a disorder of impulse control. ADD children do things other kids think of, but don't actually do. The urge to act is not being inhibited. The first response is the immediate response. People with ADD have trouble resisting the attractiveness of things other than that immediately before them. The observed hyperactivity is not independent from, but born of, the impulse control problem. To be ADD is to be hyper-responsive, not hyperactive. Failure to inhibit is at the core of the problem.
ADD has an early onset. 95% are identified by age 7; the mean is age 4. By this time, 'normal' children are learning self-control. All young children are impulsive, but they eventually learn control. 20-30% outgrow the condition. >60% (Barkley thinks it to be 75%) carry the condition in some form into adulthood.
ADD children act better in a one to one setting than in groups. They behave better in the presence of fathers than mothers. This is also observed in other children. Barkley thinks that in the mind of the child, the person (parent) who talks loses, the one who acts wins. Mothers tend to talk; fathers tend to act. He suggests that you not try to reason with your children in every situation - ADD is not a failure of reason, neither is it a failure of knowledge.
For the person with ADD, novelty is a reward. They do well with a rich schedule of feedback. Barkley calls them 'little Ed Kochs', for the New York City mayor known for asking 'How'm I doing?'. Tell them how they are doing - they want immediate feedback, for they operate on the level of immediate vs. delayed consequences/rewards. Education is delayed gratification; they want what feels good now. Those with ADD generally do better in the morning (even those who are not 'morning people' find it easier to function more close to normal in the morning). Therefore, give them the hard work in the morning, and give them something fun to do later. Its important to realize that symptoms are dependent on the environment; one is not going to see all the problems under all circumstances.
The scientist/philosopher Jacob Bronowski wrote in 'The Ascent of Man' that the most crucial event in the evolution of the human species was the appearance of the ability to wait - a trait crucial for human function. Barkley sees four aspects to this ability to wait.
1. A sense of time
The human mind can keep an event in short-term memory. The mind can freeze time by holding on to an event which has passed. Barkley's theory of the neuropsychology of ADD predicts that people with ADD will have poorer short-term memory than average individuals. If you can hold something in short-term memory you can analyze it. This ability is crucial for mental calculations, analysis, reflection. Humans can use their minds as time machines, as vehicles in which to travel between the present, past and future. Other animals cannot sustain an image in their minds. We call the ability to refer back and forth between past and present hindsight. If however, you don't wait, you don't reflect, and therefore cannot benefit as well from the wisdom of hindsight.
We are the only species in the fourth dimension: time. This sense develops between 7 and 8 years of age. Conversation at this age begins to deal with anticipation, forethought, planning. Other kinds learn to ignore stimuli which may distract from the task at hand. In contrast, the ADD child doesn't respond until the event crosses their window. They don't respond until hit by the train of time. They don't deal with things until necessary.
2. Objectivity
Once you learn to wait, you can stop an emotional response while you examine it. This is emotion vs. objectivity. I you don't wait, you will continue to be emotional, and will have difficulty separating emotion from objectivity. It's facts vs. feelings. Those with ADD are more emotional over the entire spectrum, from happy to sad; they feel their emotions more intensely than average people.
Objectivity is required to serve goal-directed behavior. Perspicacity is the kindling of motivation. Motivation is an emotion. The normal attitude with an unpleasant task is that you 'stick with it', as there is a reward at the end. In ADD, the reward must be in the task itself, not after it. Most children can kindle motivation, the ADD child has to find it in what he is doing at the time - he has trouble kindling motivation to do an unpleasant task.
3. Reflection
Humans can turn language on themselves. We call it reflection, and its the bedrock of self-control. Internalized language develops at 3-4 years of age; it is therefore no surprise that ADD is typically first noticed at this age. Speech becomes a means for self-control. You can talk to yourself in order to control yourself. This predicts disorganized internal speech in those with ADD. This was actually seen in research done 10 years ago, but it was ignored because it didn't fit into the prevailing paradigm.
The prediction is that those with ADD will seem younger than their chronological age; they will seem more child-like than their non-ADD peers. That is why ADD children are so 'chatty' and why much of their conversation deals with the present, and not the future.